Anterior Cruciate Ligament Surgery

ACL Reconstruction involves a general anaesthetic, and a hospital stay of 1 or 2 nights.

The ACL Reconstruction is aimed at replacing the deficient anterior cruciate ligament with a graft ligament usually taken from one of your hamstring tendons. This graft is then placed in the knee joint through drill holes in the bones and held in accurate position proximally with a special button, known as the Endobutton and with screws and/or staples distally.

The procedure is done mostly arthroscopically and any other procedure required is usually done at the same time.

After the surgery a prolonged course of rehabilitation follows. This requires a commitment on the part of the patient to undertake this rehabilitation in order to achieve the best possible result.

Results:  A good or excellent result is achieved in 95% of cases.

 

There are three potential problems worthy of mention:

• Infection can occur with any operation; special precautions are taken but if an infection did occur and go untreated then serious problems could occur,
•  Stiffness occurs rarely in individuals predisposed to form excessive and thick scar tissue. This is treated by surgical excision of the scar tissue. Stiffness can also occur in patients who do not progress their rehabilitation as instructed. This is usually easily correctable with increased effort.
• Failure of the graft is extremely rare but can happen if a further injury occurs in the early post-operative period.

Other potential risks from the surgery or anaesthetic are extremely rare in otherwise healthy patients. Dr Buelow is happy to discuss this with you if you wish.

If you have any questions about the operation please ask Dr Buelow before the surgery either by consultation or in the hospital.

 

Return to work depends on the type of work. The following is a guide only.

• Office work                        As soon as pain and travel to and from work allows (about 10 days)
• Driving                                 When able to walk well and when “In control of the vehicle”
• Light duties                        If the job allows limited walking between 3 and 8 weeks
• Standing                              For long periods around 6 weeks
• Activity                                 Walking, bending, lifting around 8 weeks
• Heavy work                        Full squatting, heavy lifting, 3 months

 

GENERAL PROTOCOL FOR REHABILITATION AND PHYSIOTHERAPY FOLLOWING ANTERIOR CRUCIATE LIGAMENT REPLACEMENT SURGERY

• In Hospital:                        Exercises as per physiotherapist. The dressing is changed on day following surgery, home after lunch. Mobilise partial/full weight bearing with crutches
• At home:                            Keep the dressing dry. Knee covered for showering for 1^st week

Walk with crutches as pain decreases and security and confidence increases. Walking and full weight bearing is allowed as tolerated. Continue home exercise program.  Use ice if necessary Continue anti-inflammatory until swelling settles

• At 1-2 weeks:

  • Review in office:
  • Weight bearing/walking without crutches is encouraged
  • Movement is encouraged by active & assisted active exercises
  • No forceful, sudden or painful activity is allowed

 

• At 2-6 weeks:                   

  • Gentle swimming, no hard kick’s (use pool buoy)
  • Cycling on stationary bike at 4 weeks
  • Do not ride hard, low pressure on pedals

 

• At 6 weeks:

  • More regular therapy with physiotherapist begins
  • Progress gait training, strength of hamstrings and quadriceps
  • No open kinetic chain exercises until week 12!
  • Cycling, hydrotherapy, ice if inflamed, hip strength and upper body exercises are all o.k.

 

• At 3 months: 

  • Strength of quadriceps and hamstrings with light resistance

 

• At 4 months:                     

  • Increase everything, increase speed of some exercises
  • Start light jogging, start open kinetic chain exercises

 

• At 5 months:                     

  • Begin light social sporting activity, practice zig-zags & S shapes

 

• At 6 months:                     

  • If all is well and you are confident, low level sport can be commenced

 

• 6-9 months             

  • Incorporate Agility and Landing exercises into your rehab

 

• 9-12 months

  • Return to Sport assessment  (Isokinteic strength and Hop tests)

 

Do not play unless you are fit and feel confident

Remember: If it HURTS or SWELLS you are doing too much. Slow down!

If you want a more detailed information about Biological and Biomechanical Factors for ACL Reconstruction click here